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      Anaesthetic management of a case of Wolff-Parkinson-White syndrome

      case-report

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          Abstract

          We report a case of fibroid uterus with Wolff–Parkinson–White (WPW) syndrome in a 48-year-old female, posted for elective hysterectomy. Patient gave history of short recurrent episodes of palpitation and electrocardiograph confirmed the diagnosis of WPW syndrome. The anaesthetic management of these patients is challenging as they are known to develop life threatening tachyarrhythmia like paroxysmal supra-ventricular tachycardia (PSVT) and atrial fibrillation (AF). Epidural anaesthesia is preferred compared to general anaesthesia to avoid polypharmacy, noxious stimuli of laryngoscopy and intubation. To deal with perioperative complications like PSVT and AF, anti-arrhythmic drugs like adenosine, beta blockers and defibrillator should be kept ready. Perioperative monitoring is essential as patients can develop complications.

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          Preexcitation syndromes: diagnostic consideration in the ED.

          Dustin Mark, William Brady, Jesse M. Pines (2009)
          Preexcitation syndromes are a common cause of paroxysmal tachycardias presenting to the ED. Emergency physicians should be familiar with the common electrocardiographic manifestations of preexcitation, particularly the Wolff-Parkinson-White abnormality, as these conditions require specific therapeutic management. This article reviews the pathophysiology of preexcitation, along with the electrocardiographic findings of Wolff-Parkinson-White and its associated tachyarrhythmias.
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            Electrocardiography in the patient with the Wolff-Parkinson-White syndrome: diagnostic and initial therapeutic issues.

            Carla Brady, M Kefer, Bettina Rosner … (1999)
            The Wolff-Parkinson-White syndrome (WPW), estimated to occur in approximately 0.1% to 3% of the general population, is a form of ventricular preexcitation involving an accessory conduction pathway. The definition of WPW relies on the following electrocardiographic features: (1) a PR interval less than 0.12 seconds (2) with a slurring of the initial segment of the QRS complex, known as a delta wave, (3) a QRS complex widening with a total duration greater than 0.12 seconds, and (4) secondary repolarization changes reflected in ST segment-T wave changes that are generally directed opposite (discordant) to the major delta wave and QRS complex changes. The accessory pathway bypasses the atrioventricular (AV) node, creating a direct electrical connection between the atria and ventricles. The majority of patients with preexcitation syndromes remain asymptomatic throughout their lives. When symptoms do occur they are usually secondary to tachyarrhythmias; the importance of recognizing this syndrome is that these patients may be at risk to develop a variety of supraventricular tachyarrhythmias which cause disabling symptoms and, in the extreme, sudden cardiac death. The tachyarrhythmias encountered in the WPW patient include paroxysmal supraventricular tachycardia (both the narrow QRS and wide QRS complex varieties), atrial fibrillation, atrial flutter, and ventricular fibrillation. Diagnostic and urgent, initial therapeutic issues based on initial electrocardiographic information are presented via 5 illustrative cases.
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              Development of rapid atrial fibrillation with a wide QRS complex after neostigmine in a patient with intermittent Wolff-Parkinson-White syndrome.

              I Takenaka, K Uehara-Aoyama, A Seto … (1999)
              We report the case of a 67-yr-old man with intermittent Wolff-Parkinson-White (WPW) syndrome in whom neostigmine produced life-threatening tachyarrhythmias. The patient was scheduled for microsurgery for a laryngeal tumour. When he arrived in the operating room, the electrocardiogram showed normal sinus rhythm with a rate of 82 beat min-1 and a narrow QRS complex which remained normal throughout the operative period. On emergence from anaesthesia, the sinus rhythm (87 beat min-1) changed to atrial fibrillation with a rate of 80-120 beat min-1 and a normal QRS complex. We did not treat the atrial fibrillation because the patient was haemodynamically stable. Neostigmine 1 mg without atropine was then administered to antagonize residual neuromuscular block produced by vecuronium. Two minutes later, the narrow QRS complexes changed to a wide QRS complex tachycardia with a rate of 110-180 beat min-1, which was diagnosed as rapid atrial fibrillation. As the patient was hypotensive, two synchronized DC cardioversions of 100 J and 200 J were given, which restored sinus rhythm. No electrophysiological studies of anticholinesterase drugs have been performed in patients with WPW syndrome. We discuss the use of these drugs in this condition.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Anaesth
                Journal ID (publisher-id): IJA
                Title: Indian Journal of Anaesthesia
                Publisher: Medknow Publications (India )
                ISSN (Print): 0019-5049
                ISSN (Electronic): 0976-2817
                Publication date (Print): Jul-Aug 2011
                Volume: 55
                Issue: 4
                Pages: 381-383
                Affiliations
                [1]Department of Anesthesia, KIMS Hubli, Karnataka, India
                Author notes
                Address for correspondence: Dr. Savitri D Kabade, G.O. Quarters 7/3, KIMS Campus, Vidyanagar, Hubli - 580 021, Karnataka, India. E-mail: sampradakabade@ 123456gmail.com
                Article
                Publisher ID: IJA-55-381
                DOI: 10.4103/0019-5049.84868
                PMC ID: 3190514
                PubMed ID: 22013256
                SO-VID: 0db836a9-f485-4126-828d-76321324fe6c
                Copyright © Copyright: © Indian Journal of Anaesthesia
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: epidural anaesthesia,wpw syndrome,accessory pathway,tachyarrhythmia,adenosine
                Data availability:
                ScienceOpen disciplines: Anesthesiology & Pain management
                Keywords: epidural anaesthesia, wpw syndrome, accessory pathway, tachyarrhythmia, adenosine

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